Characteristics of and Challenges Facing Older Adults With Diabetes in Institutional LTC Settings (3,19)

ALFsSNFsLTC Facilities
General characteristics• Moderate comorbidities• Variable comorbidities• Extensive comorbidities
• Focus on rehabilitation• Acute illness and instability
• Probable home discharge
Care needs• Partially dependent for ADL/iADL and medication management• Full or partial support of ADLs• Full or partial ADL dependence
• Diabetes self-care assistance for some• Possible intravenous medications, wound care, respiratory and renal support• Unable to perform diabetes self-care
• Education for diabetes self-care
Medical services• Practitioners may visit the site or require patients to be transported to offices• Practitioners make regular visits (shared by physician, ARNP, or PA)• Practitioners make regular visits (shared by physician, ARNP, or PA)
• Laboratory and radiology services (from contracted vendors)• Laboratory and radiology services• Laboratory and radiology services
• Specialist consultations require office visits• Specialists may provide in-house consultation• Specialists may provide in-house consultation
• Infusion services and wound care available• Infusion services and wound care available
Major challenges• Inability to provide regular glucose monitoring and insulin injections• New or complicated medication regimens might be too difficult for home management• Irregular meal intake
• Inadequate staff education• Acute-care transfers if medically unstable• Insulin and meal timing mismatches because of high workload
• Acute-care transfers if medically unstable• Need for some self-care by time of discharge, depending on home support• Inadequate staff education
• Visits to specialists may lead to fragmentation of care and poor communication• Suboptimal care transitions• Prolonged use of sliding‐scale insulin
• Higher risk of hypoglycemia in dementia population
• High staff turnover
• Practitioners vary in their management of diabetes
  • ADL, activities of daily living (e.g., walking, feeding, dressing and grooming, toileting, bathing, and transferring); ARNP, advanced practice nurse practitioner; iADL, instrumental ADL (e.g., cooking, taking medications, traveling, using the telephone, shopping, housework, and managing finances); PA, physician’s assistant.